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Stein MJ, Fischer B, Bohmann P, Ahrens W, Berger K, Brenner H, Günther K, Harth V, Heise JK, Karch A, Klett-Tammen CJ, Koch-Gallenkamp L, Krist L, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Nimptsch K, Obi N, Peters A, Pischon T, Schipf S, Schmidt B, Stang A, Thierry S, Willich SN, Wirkner K, Leitzmann MF, Sedlmeier AM. Differences in Anthropometric Measures Based on Sex, Age, and Health Status: Findings From the German National Cohort (NAKO). Dtsch Arztebl Int 2024:arztebl.m2024.0016. [PMID: 38377337 DOI: 10.3238/arztebl.m2024.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
BACKGROUND Obesity is a worldwide health problem. We conducted detailed analyses of anthropometric measures in a comprehensive, population-based, current cohort in Germany. METHODS In the German National Cohort (NAKO), we analyzed cross-sectional data on body-mass index (BMI), waist and hip circumference, subcutaneous (SAT) and visceral adipose tissue (VAT) as measured by ultrasound, and body fat percentage. The data were stratified by sex, age, and self-reported physicians' diagnoses of cardiovascular diseases (CVD), metabolic diseases (MetD), cardiometabolic diseases (CMD), and cancer. RESULTS Data were available from 204 751 participants (age, 49.9 ± 12.8 years; 50.5% women). Body size measures generally increased with age. Men had a higher BMI, larger waist circumference, and more VAT than women, while women had a larger hip circumference, more SAT, and a higher body fat percentage than men. For example, the mean BMI of participants over age 60 was 28.3 kg/m2 in men and 27.6 kg/m2 in women. CVD, MetD, and CMD were associated with higher anthropometric values, while cancer was not. For example, the mean BMI was 25.3 kg/m2 in healthy women, 29.4 kg/m2 in women with CMD, and 25.4 kg/m2 in women with cancer. CONCLUSION Obesity is widespread in Germany, with notable differences between the sexes in anthropometric values. Obesity was more common in older participants and those with chronic diseases other than cancer. Elevated values were especially common in multimorbid individuals.
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Weber A, van Hees VT, Stein MJ, Gastell S, Steindorf K, Herbolsheimer F, Ostrzinski S, Pischon T, Brandes M, Krist L, Marschollek M, Greiser KH, Nimptsch K, Brandes B, Jochem C, Sedlmeier AM, Berger K, Brenner H, Buck C, Castell S, Dörr M, Emmel C, Fischer B, Flexeder C, Harth V, Hebestreit A, Heise JK, Holleczek B, Keil T, Koch-Gallenkamp L, Lieb W, Meinke-Franze C, Michels KB, Mikolajczyk R, Kluttig A, Obi N, Peters A, Schmidt B, Schipf S, Schulze MB, Teismann H, Waniek S, Willich SN, Leitzmann MF, Baurecht H. Large-scale assessment of physical activity in a population using high-resolution hip-worn accelerometry: the German National Cohort (NAKO). Sci Rep 2024; 14:7927. [PMID: 38575636 PMCID: PMC10995156 DOI: 10.1038/s41598-024-58461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
Large population-based cohort studies utilizing device-based measures of physical activity are crucial to close important research gaps regarding the potential protective effects of physical activity on chronic diseases. The present study details the quality control processes and the derivation of physical activity metrics from 100 Hz accelerometer data collected in the German National Cohort (NAKO). During the 2014 to 2019 baseline assessment, a subsample of NAKO participants wore a triaxial ActiGraph accelerometer on their right hip for seven consecutive days. Auto-calibration, signal feature calculations including Euclidean Norm Minus One (ENMO) and Mean Amplitude Deviation (MAD), identification of non-wear time, and imputation, were conducted using the R package GGIR version 2.10-3. A total of 73,334 participants contributed data for accelerometry analysis, of whom 63,236 provided valid data. The average ENMO was 11.7 ± 3.7 mg (milli gravitational acceleration) and the average MAD was 19.9 ± 6.1 mg. Notably, acceleration summary metrics were higher in men than women and diminished with increasing age. Work generated in the present study will facilitate harmonized analysis, reproducibility, and utilization of NAKO accelerometry data. The NAKO accelerometry dataset represents a valuable asset for physical activity research and will be accessible through a specified application process.
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Affiliation(s)
- Andrea Weber
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | | | - Michael J Stein
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Florian Herbolsheimer
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Stefan Ostrzinski
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Mirko Brandes
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
| | - Michael Marschollek
- Hannover Medical School, Peter L. Reichertz Institute for Medical Informatics, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
| | - Karin Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Katharina Nimptsch
- Molecular Epidemiology Research Group, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Anja M Sedlmeier
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Buck
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Stefanie Castell
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, Greifswald, Germany
| | - Carina Emmel
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beate Fischer
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Claudia Flexeder
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459, Hamburg, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Jana-Kristin Heise
- Department for Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexander Kluttig
- Institute for Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg (ZfAM), University Medical Center Hamburg-Eppendorf (UKE), Seewartenstraße 10, 20459, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
- Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany
| | - Henning Teismann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Sabina Waniek
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Stefan N Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10098, Berlin, Germany
| | - Michael F Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Hansjörg Baurecht
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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3
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Yang K, Doege D, Thong MSY, Koch-Gallenkamp L, Weisser L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeissig SR, Pritzkuleit R, Jansen L, Brenner H, Arndt V. Diabetes mellitus in long-term survivors with colorectal, breast, or prostate cancer: Prevalence and prognosis. A population-based study. Cancer 2024; 130:1158-1170. [PMID: 37996981 DOI: 10.1002/cncr.35133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Patients with cancer are at increased risk of diabetes mellitus (DM). Previous studies on the prevalence and prognostic impact of DM in cancer survivors were limited by small sample sizes or short follow-up times. We aimed to compare the patient-reported prevalence of DM in long-term cancer survivors (LTCS), who survived 5 years or more after cancer diagnosis, with that in cancer-free controls, and to estimate the mortality risk among LTCS according to DM status. METHODS Our population-based cohort comprised 6952 LTCS diagnosed with breast, colorectal, or prostate cancer between 1994 and 2004, recruited in 2008-2011 (baseline), and followed until 2019. A total of 1828 cancer-free individuals served as controls. Multivariable logistic regression was used to compare the prevalence of DM in LTCS and controls, and according to covariates at baseline. Mortality among LTCS according to DM was assessed by Cox proportional hazards regression. RESULTS A total of 962 (13.8%) LTCS at baseline reported DM. Prevalence of DM in LTCS was not higher than in cancer-free controls, both at baseline (odds ratio, 0.80; 95% CI, 0.66-0.97) and at follow-up (odds ratio, 0.83; 95% CI, 0.67-1.04). Prevalence of DM in LTCS was associated with cancer site, older age, lower education, higher socioeconomic deprivation, higher body mass index, physical inactivity, other comorbidities, and poorer prognosis (adjusted hazard ratio [all-cause mortality] = 1.29; 95% CI, 1.15-1.44). CONCLUSION DM in LTCS is prevalent, but not higher than in cancer-free population controls. Cancer survivors with concurrent DM are at a potentially higher risk of death. PLAIN LANGUAGE SUMMARY Cancer and diabetes mellitus (DM) are two serious threats to global health. In our study, prevalence of DM in long-term cancer survivors who survived 5 years or more after cancer diagnosis was not higher than in cancer-free controls. This should not be interpreted as an indication of a lower risk of DM in cancer survivors. Rather, it highlights the potentially poor prognosis in diabetic cancer survivors. Therefore, keeping a continuous satisfactory DM and hyperglycemia management is essential during long-term cancer survivorship.
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Affiliation(s)
- Keyi Yang
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Linda Weisser
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sylke Ruth Zeissig
- Cancer Registry of Rhineland-Palatinate, Mainz, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), Julius Maximilian University of Würzburg, Würzburg, Germany
| | | | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
- Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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4
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Wiessner C, Licaj S, Klein J, Bohn B, Brand T, Castell S, Führer A, Harth V, Heier M, Heise JK, Holleczek B, Jaskulski S, Jochem C, Koch-Gallenkamp L, Krist L, Leitzmann M, Lieb W, Meinke-Franze C, Mikolajczyk R, Moreno Velásquez I, Obi N, Pischon T, Schipf S, Thierry S, Willich SN, Zeeb H, Becher H. Health Service Use Among Migrants in the German National Cohort-The Role of Birth Region and Language Skills. Int J Public Health 2024; 69:1606377. [PMID: 38510525 PMCID: PMC10952844 DOI: 10.3389/ijph.2024.1606377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024] Open
Abstract
Objective: To compare health service use (HSU) between migrants and non-migrants in Germany. Methods: Using data from the population-based German National Cohort (NAKO), we compared the HSU of general practitioners, medical specialists, and psychologists/psychiatrists between six migrant groups of different origins with the utilization of non-migrants. A latent profile analysis (LPA) with a subsequent multinomial regression analysis was conducted to characterize the HSU of different groups. Additionally, separate regression models were calculated. Both analyses aimed to estimate the direct effect of migration background on HSU. Results: In the LPA, the migrant groups showed no relevant differences compared to non-migrants regarding HSU. In separate analyses, general practitioners and medical specialists were used comparably to slightly more often by first-generation migrants from Eastern Europe, Turkey, and resettlers. In contrast, the use of psychologists/psychiatrists was substantially lower among those groups. Second-generation migrants and migrants from Western countries showed no differences in their HSU compared to non-migrants. Conclusion: We observed a low mental HSU among specific migrant groups in Germany. This indicates the existence of barriers among those groups that need to be addressed.
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Affiliation(s)
- Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sara Licaj
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Klein
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | - Amand Führer
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Heier
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- KORA Study Centre, University Hospital Augsburg, Augsburg, Germany
| | - Jana-Kristin Heise
- Department of Epidemiology, Helmholtz Center for Infection Research, Brunswick, Germany
| | | | - Stefanie Jaskulski
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Carmen Jochem
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Faculty of Medicine, University of Kiel, Kiel, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ilais Moreno Velásquez
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
| | - Nadia Obi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Pischon
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Molecular Epidemiology Research Group, Berlin, Germany
- Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association (MDC), Biobank Technology Platform, Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Schipf
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Germany
| | - Sigrid Thierry
- Institute of Epidemiology, Helmholtz Zentrum München—German Research Center for Environmental Health (GmbH), Neuherberg, Germany
- Augsburg University Hospital, Augsburg, Germany
| | - Stefan N. Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
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5
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Koschig M, Conrad I, Berger K, Baune BT, Grabe HJ, Gerstorf D, Meinke-Franze C, Völzke H, Mikolajczyk R, Leitzmann M, Fricke J, Keil T, Koch-Gallenkamp L, Perna L, Obi N, Pabst A, Riedel-Heller SG. The mediating role of personality traits in the association between childhood trauma and depressive symptoms in young adulthood. J Affect Disord 2023; 338:373-379. [PMID: 37331380 DOI: 10.1016/j.jad.2023.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/25/2023] [Accepted: 06/15/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The aim of this study was to investigate the mediating role of the Big 5 personality traits (extraversion, neuroticism, openness, agreeableness, conscientiousness) in the association between early traumatization and depressive symptoms in early adulthood (20-25-year-olds) in a German population-based sample. METHODS A total of 3176 participants from the German National Cohort (NAKO) baseline with an age between 20 and 25 years were included in this investigation. The sum score of the 9-item-version of the Patient Health Questionnaire was used for assessment of depressive symptoms. A structural equation model was built to test the paths between childhood trauma, Big 5 personality traits and depressive symptoms. RESULTS Overall, 10.7 % of the young adult sample had a PHQ-9 sum score of ten or higher. The final mediation model fitted well for young adults. We found evidence for a partial mediating effect of Big 5 personality traits. LIMITATIONS We only adjusted for age, sex, and year of data collection and did not include biological factors in the model. CONCLUSION Young adults with early trauma experiences have a risk for developing depressive symptoms in young adulthood. Personality traits, especially neuroticism, partially mediated the association between early trauma and depressive symptoms for young adults and should be recognized in preventive strategies.
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Affiliation(s)
- Maria Koschig
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany.
| | - Ines Conrad
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Klaus Berger
- Institute of Epidemiology & Social Medicine, University of Münster, Münster, Germany
| | - Bernhard T Baune
- Department of Psychiatry, University of Münster, Germany; Department of Psychiatry, Melbourne Medical School, University of Melbourne, Australia; The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Australia
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Denis Gerstorf
- Humboldt University Berlin, German Institute for Economic Research (DIW) Berlin, Berlin, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle Wittenberg, Germany; German Center for Mental Health (DZPG), Site Jena-Magdeburg-Halle, Germany; Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Michael Leitzmann
- Department of Epidemiology and Preventive Medicine, Regensburg University Medical Center, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Lena Koch-Gallenkamp
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Heidelberg, Germany
| | - Laura Perna
- Department Genes and Environment, Max Planck Institute of Psychiatry, Munich, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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6
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Liu Z, Thong MSY, Doege D, Koch-Gallenkamp L, Weisser L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeissig SR, Pritzkuleit R, Brenner H, Arndt V. Benefit finding, posttraumatic growth and health-related quality of life in long-term cancer survivors: a prospective population-based study. Acta Oncol 2023; 62:1124-1131. [PMID: 37594165 DOI: 10.1080/0284186x.2023.2245560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND We explored the relationship between benefit finding (BF)/posttraumatic growth (PTG) at baseline and health-related quality of life (HRQOL) at baseline and follow-up in long-term cancer survivors (LTCS; ≥5-year post-diagnosis). MATERIALS AND METHODS HRQOL was assessed in LTCS in 2009-2011 (5- to 16-year post-diagnosis, baseline) and re-assessed in 2018/2019 (14- to 24-year post-diagnosis, follow-up). BF and PTG were measured at baseline; mean scores were dichotomized into 'none-to-low' (<3) and 'moderate-to-high' (> =3). Linear regression models and linear mixed regression models were employed to assess the association of BF/PTG with HRQOL. RESULTS Of the 6057 baseline participants, 4373 were alive in 2019, of whom 2704 completed the follow-up questionnaire. Cross-sectionally, LTCS with none-to-low BF reported better HRQOL at baseline and at follow-up than LTCS with higher BF. Longitudinally, no difference was found between none-to-low and moderate-to-high BF on the HRQOL change from baseline to follow-up. HRQOL differences between the PTG groups were not statistically significant cross-sectionally and longitudinally, except those participants with moderate-to-high PTG reported higher role functioning and global health status/QOL. CONCLUSIONS Cross-sectionally, BF was significantly negatively related to subscales of HRQOL, while PTG was positively correlated to role functioning and global health status/QOL. The results add further evidence that BF and PTG are two different positive psychological concepts.
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Affiliation(s)
- Zhunzhun Liu
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Linda Weisser
- Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | - Sylke Ruth Zeissig
- Cancer Registry Rhineland-Palatinate, Mainz, Germany
- Institute of Clinical Epidemiology and Biometry (ICE-B), Julius Maximilian University of Wuerzburg, Würzburg, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
- Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Vonneilich N, Becher H, Bohn B, Brandes B, Castell S, Deckert A, Dragano N, Franzke CW, Führer A, Gastell S, Greiser H, Keil T, Klett-Tammen C, Koch-Gallenkamp L, Krist L, Leitzmann M, Meinke-Franze C, Mikolajczyk R, Moreno Velasquez I, Obi N, Peters A, Pischon T, Reuter M, Schikowski T, Schmidt B, Schulze M, Sergeev D, Stang A, Völzke H, Wiessner C, Zeeb H, Lüdecke D, von dem Knesebeck O. Associations of Migration, Socioeconomic Position and Social Relations With Depressive Symptoms - Analyses of the German National Cohort Baseline Data. Int J Public Health 2023; 68:1606097. [PMID: 37533684 PMCID: PMC10391163 DOI: 10.3389/ijph.2023.1606097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Objectives: We analyze whether the prevalence of depressive symptoms differs among various migrant and non-migrant populations in Germany and to what extent these differences can be attributed to socioeconomic position (SEP) and social relations. Methods: The German National Cohort health study (NAKO) is a prospective multicenter cohort study (N = 204,878). Migration background (assessed based on citizenship and country of birth of both participant and parents) was used as independent variable, age, sex, Social Network Index, the availability of emotional support, SEP (relative income position and educational status) and employment status were introduced as covariates and depressive symptoms (PHQ-9) as dependent variable in logistic regression models. Results: Increased odds ratios of depressive symptoms were found in all migrant subgroups compared to non-migrants and varied regarding regions of origins. Elevated odds ratios decreased when SEP and social relations were included. Attenuations varied across migrant subgroups. Conclusion: The gap in depressive symptoms can partly be attributed to SEP and social relations, with variations between migrant subgroups. The integration paradox is likely to contribute to the explanation of the results. Future studies need to consider heterogeneity among migrant subgroups whenever possible.
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Affiliation(s)
- Nico Vonneilich
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heiko Becher
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Barbara Bohn
- NAKO e.V., Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Berit Brandes
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Andreas Deckert
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Nico Dragano
- Institute for Medical Sociology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Claus-Werner Franzke
- Institute for Prevention and Cancer Epidemiology, University of Freiburg Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Amand Führer
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Sylvia Gastell
- NAKO Study Center, German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
| | - Halina Greiser
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Faculty of Medicine, University of Würzburg, Würzburg, Bavaria, Germany
- State Institute of Health I, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Carolina Klett-Tammen
- Department of Epidemiology, Helmholtz Center for Infection Research, Helmholtz Association of German Research Centers (HZ), Braunschweig, Niedersachsen, Germany
| | - Lena Koch-Gallenkamp
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany
| | - Michael Leitzmann
- Deptartment of Epidemiology and Preventive Medicine, University Medical Center Regensburg, Regensburg, Bavaria, Germany
| | - Claudia Meinke-Franze
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), University Hospital in Halle, Halle, Saxony-Anhalt, Germany
| | - Ilais Moreno Velasquez
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
| | - Nadia Obi
- Institute for Occupational and Maritime Medicine Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Center München, Helmholtz Association of German Research Centres (HZ), Neuherberg, Germany
| | - Tobias Pischon
- Molecular Epidemiology Research Group, Max Delbrück Center for Molecular Medicine, Helmholtz Association of German Research Centers (HZ), Berlin, Baden-Wurttemberg, Germany
- Berlin Institute of Health (BIH), Charité University Medicine Berlin, Berlin, Germany
| | - Marvin Reuter
- Subject Sociology, University of Bamberg, Bamberg, Bavaria, Germany
| | - Tamara Schikowski
- Leibniz-Institut für Umweltmedizinische Forschung (IUF), Dusseldorf, Germany
| | - Börge Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Matthias Schulze
- German Institute of Human Nutrition Potsdam-Rehbruecke (DIfE), Potsdam, Brandenburg, Germany
- Institute of Nutrition Science, Faculty of Mathematics and Natural Sciences, University of Potsdam, Potsdam, Brandenburg, Germany
| | - Dmitry Sergeev
- Department of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Baden-Württemberg, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology, Essen University Hospital, Essen, North Rhine-Westphalia, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medical Center Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Christian Wiessner
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (LG), Bremen, Germany
| | - Daniel Lüdecke
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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8
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Thong MSY, Doege D, Weißer L, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeissig SR, Brenner H, Arndt V. Persisting Deficits in Health-Related Quality of Life of Colorectal Cancer Survivors 14–24 Years Post-Diagnosis: A Population-Based Study. Curr Oncol 2023; 30:3373-3390. [PMID: 36975470 PMCID: PMC10047200 DOI: 10.3390/curroncol30030257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/07/2023] [Accepted: 03/10/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14–24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical factors. (2) Methods: We used data from 506 long-term CRC survivors and 1489 controls recruited from German population-based multi-regional studies. HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC QLQ-C30) questionnaire. We estimated differences in the HRQOL of CRC survivors and controls with multiple regression, adjusted for age at survey, sex, and education, where appropriate. (3) Results: CRC survivors reported poorer social functioning but better health status/QOL than controls. CRC survivors, in general, had higher levels of symptom burden, and in particular diarrhea and constipation, regardless of demographic or clinical factors. In stratified analyses, HRQOL differed by age, sex, cancer type, and having a permanent stoma. (4) Conclusions: Although CRC survivors may have a comparable health status/QOL to controls 14–24 years after diagnosis, they still live with persistent bowel dysfunction that can negatively impact aspects of functioning. Healthcare providers should provide timely and adapted follow-up care to ameliorate potential long-term suffering.
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Affiliation(s)
- Melissa S. Y. Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-6221-42-2334
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Linda Weißer
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, 44801 Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology—BIPS, 28359 Bremen, Germany
| | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, 23538 Lübeck, Germany
| | - Sylke Ruth Zeissig
- Institute of Clinical Epidemiology and Biometry (ICE-B), Julius Maximilian University of Würzburg, 97080 Würzburg, Germany
- Cancer Registry of Rhineland-Palatinate, 55116 Mainz, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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9
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Thong MSY, Doege D, Weißer L, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeissig SR, Pritzkuleit R, Schlander M, Brenner H, Arndt V. Health and life insurance-related problems in very long-term cancer survivors in Germany: a population-based study. J Cancer Res Clin Oncol 2021; 148:155-162. [PMID: 34642793 PMCID: PMC8752534 DOI: 10.1007/s00432-021-03825-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/03/2021] [Indexed: 11/17/2022]
Abstract
Purpose Limited research suggests that cancer survivors have problems with insurance. Our study aimed to gain insight into the proportion of very long-term (14–24 years post-diagnosis) survivors of breast, colorectal, and prostate cancers who had problems with health (HI) and life (LI) insurance. Methods We used data from CAESAR (CAncEr Survivorship—A multi-Regional population-based study). Participants completed questions on change in insurance providers since cancer diagnosis, problems with requesting (additional) HI or LI, and how potential problems were resolved. We conducted logistic regression to determine factors associated with change in statutory HI. Results Of the 2714 respondents, 174 (6%) reported having changed HI providers. Most switched between different statutory HI providers (86%), 9% from statutory to private, and 5% from private to statutory. Respondents who changed statutory HI providers were more likely to be prostate cancer survivors (OR 2.79, 95% CI 1.01–7.68) while being ≥ 65 years at time of diagnosis (OR 0.58, 95% CI 0.35–0.96) and having ≥ 2 comorbid conditions (OR 0.61, 95% CI 0.40–0.92) were associated with reduced odds for change. Problems in changing HI were minimal and were resolved with additional contribution. Of the 310 respondents who tried to get LI, 25 respondents reported having difficulties, of whom the majority had their request rejected. Conclusion Most cancer survivors did not change their HI nor tried to buy LI after cancer diagnosis. Problems with changing statutory HI were generally resolved with additional contribution while the main problem encountered when buying LI was rejection of request. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-021-03825-x.
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Affiliation(s)
- Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), PO Box 101949, 69009, Heidelberg, Germany.
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), PO Box 101949, 69009, Heidelberg, Germany
| | - Linda Weißer
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany
| | | | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany.,Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), PO Box 101949, 69009, Heidelberg, Germany
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10
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Liu Z, Thong MSY, Doege D, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Waldmann A, Zeissig SR, Pritzkuleit R, Brenner H, Arndt V. Prevalence of benefit finding and posttraumatic growth in long-term cancer survivors: results from a multi-regional population-based survey in Germany. Br J Cancer 2021; 125:877-883. [PMID: 34215852 PMCID: PMC8437934 DOI: 10.1038/s41416-021-01473-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/28/2021] [Accepted: 06/17/2021] [Indexed: 11/09/2022] Open
Abstract
Background Cancer studies reported mixed results on benefit finding (BF) and posttraumatic growth (PTG) prevalence and few were focused on long-term survivors. Methods BF and PTG were assessed in a multi-regional population-based study in Germany with 6952 breast, colorectal and prostate cancer survivors, using the Benefit Finding Scale and Posttraumatic Growth Inventory. We calculated the age-adjusted prevalence, stratified by demographical and clinical characteristics. Results Overall, 66.0% of cancer survivors indicated moderate-to-high BF, and 20.5% moderate-to-high PTG. Age-adjusted prevalence of BF and PTG differed according to cancer type (breast > colorectal > prostate) and sex (female > male). BF and PTG prevalence were higher in younger than in older respondents; the age-adjusted prevalence was higher in respondents who survived more years after diagnosis. The strength and direction of associations of age-adjusted prevalence with cancer stage, disease recurrence, and time since diagnosis varied according to cancer type and sex. Conclusions A substantial proportion of long-term cancer survivors reported moderate-to-high BF and PTG. However, the prevalence was lower in older and male cancer survivors, and during the earlier years after cancer diagnosis. Further longitudinal studies on PTG and BF in cancer survivors are warranted to address heterogeneity in survivors’ experience after cancer diagnosis.
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Affiliation(s)
- Zhunzhun Liu
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Annika Waldmann
- Hamburg Cancer Registry, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany.,Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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11
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Liu Z, Doege D, Thong MSY, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Nennecke A, Waldmann A, Zeißig SR, Pritzkuleit R, Arndt V. Distress mediates the relationship between cognitive appraisal of medical care and benefit finding/posttraumatic growth in long-term cancer survivors. Cancer 2021; 127:3680-3690. [PMID: 34196976 DOI: 10.1002/cncr.33684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The objective of this study was to ascertain long-term cancer survivors' (LTCS') appraisal of medical care and how these perceptions may influence their health and well-being, including benefit finding (BF) and posttraumatic growth (PTG). METHODS In total, 6952 LTCS from a multiregional population-based study in Germany completed the Benefit Finding Scale, the Posttraumatic Growth Inventory, the Questionnaire on Stress in Cancer, and self-designed questions on cognitive appraisal of medical care. The authors explored the mediating role of distress between medical care appraisal and BF and PTG and the possible moderation of time since diagnosis in this relationship. RESULTS LTCS' medical care appraisals ("no unresolved/untreated symptoms," "satisfaction with cancer care," and "satisfaction with care for other diseases") were positively associated with BF. PTG was positively associated with "no unresolved/untreated symptoms" and negatively associated with "satisfaction with care for other diseases." Cancer distress partially mediated the associations between appraisals of medical care and BF, between "no unresolved/untreated symptoms" and PTG and between "satisfaction with care for other diseases" and PTG; whereas it totally mediated the association between "satisfaction with cancer care" and PTG. Time was a significant moderator in the model; the negative indirect effect of cognitive appraisal on BF and PTG through cancer distress weakened with longer time since diagnosis. CONCLUSIONS Cancer survivors' medical care appraisal is associated with their perceptions of BF and PTG through distress. Therefore, distress screening could be part of the regular workup to identify distressed cancer survivors who are not satisfied with medical care; these survivors may benefit from interventions to reduce distress and increase BF and PTG.
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Affiliation(s)
- Zhunzhun Liu
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty of Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | | | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Doege D, Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldmann A, Zeissig SR, Brenner H, Arndt V. Age-specific prevalence and determinants of depression in long-term breast cancer survivors compared to female population controls. Cancer Med 2020; 9:8713-8721. [PMID: 33022889 PMCID: PMC7666751 DOI: 10.1002/cam4.3476] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background Depression is more prevalent in breast cancer (BC) survivors than in the general population. However, little is known about depression in long‐term survivors. Study objectives were: (1) to compare the age‐specific prevalence of depressive symptoms (a) in BC survivors vs female population controls, (b) in disease‐free BC survivors vs BC survivors with self‐reported recurrence vs controls, and (2) to explore determinants of depression in BC survivors. Methods About 3010 BC survivors (stage I‐III, 5‐16 years post‐diagnosis), and 1005 population controls were recruited in German multi‐regional population‐based studies. Depression was assessed by the Geriatric Depression Scale‐15. Prevalence of mild/severe and severe depression only were estimated via logistic regression, controlling for age and education. Multinomial logistic regression was used to explore determinants of mild and severe depression. Results Compared with population controls, BC survivors were more likely to report mild/severe depression (30.4% vs 23.8%, p = .0003), adjusted for age and education. At all age groups <80 years, prevalence of both mild/severe and severe depression only was significantly higher in BC survivors, while BC survivors ≥80 years reported severe depression less frequently than controls. BC survivors with recurrence reported significantly higher prevalence of mild/severe depression than disease‐free survivors and controls, but prevalence in disease‐free survivors and controls was comparable. Age, income, living independently, recurrence, and BMI were significant determinants of mild depression in BC survivors. Age, education, employment, income, recurrence, and BMI were significant determinants of severe depression. Conclusions Long‐term BC survivors <80 years report significantly higher prevalence of depressive symptoms than controls, which might be explained by recurrence and individual factors. The findings suggest that depression in BC survivors is common, and even more after BC recurrence. Clinicians should routinize screening and normalize referral to psychological care.
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Affiliation(s)
- Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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13
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Eyl RE, Thong MSY, Carr PR, Jansen L, Koch-Gallenkamp L, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Physical activity and long-term fatigue among colorectal cancer survivors - a population-based prospective study. BMC Cancer 2020; 20:438. [PMID: 32423448 PMCID: PMC7236466 DOI: 10.1186/s12885-020-06918-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 04/30/2020] [Indexed: 12/31/2022] Open
Abstract
Background Evidence suggests that physical activity (PA) is beneficial for reducing fatigue in colorectal cancer (CRC) survivors. However, little is known regarding long-term effects of PA on fatigue and whether pre-diagnosis PA is associated with less fatigue in the years after diagnosis. Our study aimed to investigate the association of pre- and post-diagnosis PA with long-term fatigue in CRC survivors. Methods This study used a German population-based cohort of 1781 individuals, diagnosed with CRC in 2003–2014, and alive at five-year follow-up (5YFU). Physical activity was assessed at diagnosis and at 5YFU. Fatigue was assessed by the Fatigue Assessment Questionnaire and the EORTC Quality of Life Questionnaire-Core 30 fatigue subscale at 5YFU. Multivariable linear regression was used to explore associations between pre- and post-diagnosis PA and fatigue at 5YFU. Results No evidence was found that pre-diagnosis PA was associated with less fatigue in long-term CRC survivors. Pre-diagnosis work-related PA and vigorous PA were even associated with higher levels of physical (Beta (ß) = 2.52, 95% confidence interval (CI) = 1.14–3.90; ß = 2.03, CI = 0.65–3.41), cognitive (ß = 0.17, CI = 0.05–0.28; ß = 0.13, CI = 0.01–0.25), and affective fatigue (ß = 0.26, CI = 0.07–0.46; ß = 0.21, CI = 0.02–0.40). In cross-sectional analyses, post-diagnosis PA was strongly associated with lower fatigue on all scales. Conclusions In this study, pre-diagnosis PA does not appear to be associated with less fatigue among long-term CRC survivors. Our results support the importance of ongoing PA in long-term CRC survivors. Our findings might be used as a basis for further research on specific PA interventions to improve the long-term outcome of CRC survivors.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Cancer Epidemiology Group, University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Martinistraße 54, 20251, Hamburg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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14
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Eyl RE, Koch-Gallenkamp L, Jansen L, Walter V, Carr PR, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Physical Activity and Long-term Quality of Life among Colorectal Cancer Survivors-A Population-based Prospective Study. Cancer Prev Res (Phila) 2020; 13:611-622. [PMID: 32253267 DOI: 10.1158/1940-6207.capr-19-0377] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 12/23/2019] [Accepted: 03/30/2020] [Indexed: 12/24/2022]
Abstract
Evidence suggests that physical activity (PA) is positively associated with (health-related) quality of life (QOL) in colorectal cancer survivors. However, little is known regarding long-term effects of PA on QOL and if prediagnosis PA is associated with QOL in the years after diagnosis. Our study aimed to investigate the association of prediagnosis and postdiagnosis PA with long-term QOL in colorectal cancer survivors.This study is based on a population-based cohort from Germany of 1,781 newly diagnosed colorectal cancer survivors over a 5-year period. PA was assessed at diagnosis and at 5-year follow-up (5YFU). Quality of life was assessed by the European Organisation for Research and Treatment of Cancer C Quality of Life Questionnaire QLQ-C30 at 5YFU. Multivariable linear regression was used to explore associations between prediagnosis and postdiagnosis PA and QOL at 5YFU.No evidence of a positive association between higher levels of prediagnosis PA and better long-term QOL was found. Higher levels of prediagnosis work-related PA and vigorous PA were even associated with decreased QOL in domains such as cognitive [Beta(β) = -2.52, 95% confidence interval (CI) = -3.77, -1.27; β = -1.92, CI = -3.17, -0.67) and emotional functioning (β = -2.52, CI = -3.84, -1.19; β = -2.12, CI = -3.44, -0.80). In cross-sectional analyses, higher postdiagnosis PA was strongly associated with higher QOL. Survivors physically active at both prediagnosis and postdiagnosis as well as survivors who increased their PA between prediagnosis and postdiagnosis reported significantly higher long-term QOL compared with survivors who remained inactive at prediagnosis and postdiagnosis. In this study, higher prediagnosis PA does not appear to be associated with higher QOL among long-term colorectal cancer survivors but our results support the importance of ongoing PA throughout survivorship.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Medical Faculty Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Prudence R Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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15
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Wiessner C, Keil T, Krist L, Zeeb H, Dragano N, Schmidt B, Ahrens W, Berger K, Castell S, Fricke J, Führer A, Gastell S, Greiser H, Guo F, Jaeschke L, Jochem C, Jöckel KH, Kaaks R, Koch-Gallenkamp L, Krause G, Kuss O, Legath N, Leitzmann M, Lieb W, Meinke-Franze C, Meisinger C, Mikolajczyk R, Obi N, Pischon T, Schipf S, Schmoor C, Schramm S, Schulze MB, Sowarka N, Waniek S, Wigmann C, Willich SN, Becher H. [Persons with migration background in the German National Cohort (NAKO)-sociodemographic characteristics and comparisons with the German autochthonous population]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:279-289. [PMID: 32034443 DOI: 10.1007/s00103-020-03097-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far. OBJECTIVES Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test). METHODS Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents. RESULTS Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99). CONCLUSION PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.
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Affiliation(s)
- Christian Wiessner
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
| | - Thomas Keil
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Institut für Klinische Epidemiologie und Biometrie, Universität Würzburg, Würzburg, Deutschland.,Landesinstitut für Gesundheit, Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Bad Kissingen, Deutschland
| | - Lilian Krist
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Hajo Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Nico Dragano
- Institut für Medizinische Soziologie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Börge Schmidt
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Wolfgang Ahrens
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Bremen, Deutschland.,Institut für Statistik, Fachbereich Mathematik und Informatik, Universität Bremen, Bremen, Deutschland
| | - Klaus Berger
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Stefanie Castell
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland
| | - Julia Fricke
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Amand Führer
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Sylvia Gastell
- NAKO Studienzentrum, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Halina Greiser
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Feng Guo
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lina Jaeschke
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland
| | - Carmen Jochem
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Karl-Heinz Jöckel
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Rudolf Kaaks
- Abteilung Epidemiologie von Krebserkrankungen, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Lena Koch-Gallenkamp
- Abteilung Klinische Epidemiologie und Alternsforschung, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Gérard Krause
- Abteilung für Epidemiologie, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig, Deutschland.,Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Oliver Kuss
- Institut für Biometrie und Epidemiologie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Nicole Legath
- Institut für Epidemiologie und Sozialmedizin, Universität Münster, Münster, Deutschland
| | - Michael Leitzmann
- Institut für Epidemiologie und Präventivmedizin, Universität Regensburg, Regensburg, Deutschland
| | - Wolfgang Lieb
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Meinke-Franze
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Christa Meisinger
- SFG Klinische Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland.,Lehrstuhl für Epidemiologie am UNIKA-T Augsburg, Ludwig-Maximilians-Universität München, Augsburg, Deutschland.,NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Rafael Mikolajczyk
- Institut für Medizinische Epidemiologie, Biometrie und Informatik (IMEBI), Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Nadia Obi
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
| | - Tobias Pischon
- Forschergruppe Molekulare Epidemiologie, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC), Berlin, Deutschland.,Charité - Universitätsmedizin Berlin, Berlin, Deutschland.,Partnerstandort Berlin, Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Berlin, Deutschland.,MDC/BIH Biobank, Max-Delbrück-Centrum für Molekulare Medizin in der Helmholtz-Gemeinschaft (MDC) und Berlin Institute of Health (BIH), Berlin, Deutschland
| | - Sabine Schipf
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Claudia Schmoor
- Zentrum Klinische Studien, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Sara Schramm
- Medizinische Informatik, Biometrie und Epidemiologie (IMIBE), Medizinische Fakultät, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland
| | - Matthias B Schulze
- Abteilung Molekulare Epidemiologie, Deutsches Institut für Ernährungsforschung Potsdam-Rehbrücke, Nuthetal, Deutschland
| | - Nicole Sowarka
- NAKO Studienzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland.,Institut für Epidemiologie, Helmholtz Zentrum München, Neuherberg, Deutschland
| | - Sabina Waniek
- Institut für Epidemiologie, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Claudia Wigmann
- IUF-Leibniz Institut für umweltmedizinische Forschung, Düsseldorf, Deutschland
| | - Stefan N Willich
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Heiko Becher
- Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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16
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Adam S, Doege D, Koch-Gallenkamp L, Thong MSY, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Jansen L, Rohrmann S, Brenner H, Arndt V. Age-specific health-related quality of life in disease-free long-term prostate cancer survivors versus male population controls-results from a population-based study. Support Care Cancer 2019; 28:2875-2885. [PMID: 31736000 DOI: 10.1007/s00520-019-05120-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatment may affect PC survivors differently with respect to age. However, little is known regarding age-specific health-related quality of life (HRQoL) in PC survivors 5 years or even ≥ 10 years post-diagnosis. METHODS The sample included 1975 disease-free PC survivors (5-16 years post-diagnosis) and 661 cancer-free population controls, recruited from two German population-based studies (CAESAR+, LinDe). HRQoL in both populations was assessed using the EORTC QLQ-C30 questionnaire. Additionally, PC survivors completed the PC-specific EORTC QLQ-PR25 questionnaire. Differences in HRQoL between survivors and controls, as well as differences according to age and time since diagnosis were analyzed with multiple regression after adjustment for age, education, stage, and time since diagnosis, where appropriate. RESULTS In general, PC survivors reported HRQoL and symptom-burden levels comparable to the general population, except for significantly poorer social functioning and higher burden for diarrhea and constipation. In age-specific analyses, PC survivors up to 69 years indicated poorer global health and social functioning than population controls. Stratification by time since diagnosis revealed little difference between the subgroups. On PC-specific symptoms, burden was highest for urinary bother and symptoms, and lowest for bowel symptoms. Younger age was associated with less urinary symptoms but higher urinary bother. CONCLUSION Long-term disease-free PC survivors reported overall good HRQoL, but experienced persistent specific detriments. Our data suggest that these detriments do not improve substantially with increasing time since diagnosis. Targeted interventions are recommended to prevent PC-related and treatment-related symptoms becoming chronic and to enhance social functioning.
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Affiliation(s)
- Salome Adam
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Daniela Doege
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Melissa S Y Thong
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Gesundheitscampus 10, 44801, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident Baltz Straße 5, 66119, Saarbrücken, Germany
| | - Ron Pritzkuleit
- Schleswig-Holstein Cancer Registry, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | | | - Annika Waldmann
- Hamburg Cancer Registry, Billstraße 80, 20539, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sylke Ruth Zeissig
- Cancer Registry of Rhineland-Palatinate, Große Bleiche 46, 55116, Mainz, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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17
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Thong MSY, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Brenner H, Arndt V. Age-specific health-related quality of life in long-term and very long-term colorectal cancer survivors versus population controls - a population-based study . Acta Oncol 2019; 58:801-810. [PMID: 30736716 DOI: 10.1080/0284186x.2018.1557340] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: Previous research suggests an age differential in health-related quality of life (HRQOL) among long-term (5-10 years post-diagnosis, LTS) colorectal cancer (CRC) survivors. Few studies have specifically addressed the association of age differentials with HRQOL for very long-term CRC survivors (>10 years post-diagnosis, VLTS) and non-cancer population controls. We aimed to assess possible deficits in HRQOL of disease-free CRC-LTS and CRC-VLTS in comparison with non-cancer population controls, and whether the observed pattern varies by age and time since diagnosis. Methods: We used data from the CAncEr Survivorship - A multi-Regional (CAESAR+) study in collaboration with five population-based German cancer registries. HRQOL from controls was accessed from the Lebensqualität in DEeutschland (LinDE) study. All respondents completed the European Organization for Research and Treatment of Cancer Quality of Life Core-30 questionnaire. We calculated least square means of HRQOL scores. Analyses were adjusted for age, sex, and education, where appropriate. Results: The sample included 862 CRC-LTS, 400 CRC-VLTS and 1689 controls. CRC survivors reported overall good HRQOL but significantly poorer social functioning and more problems with dyspnea, constipation, diarrhea and finances than controls. When stratified by age, deficits in functioning and global health, and more problems with symptoms and finances were noted mainly among younger CRC survivors. Further stratification by time since diagnosis showed that similar deficits in HRQOL and symptoms were noted mainly among the younger CRC-LTS group when compared with controls. Generally, CRC-VLTS reported comparable HRQOL to controls. An exception was noted for diarrhea, whereby CRC survivors, regardless of age and time since diagnosis, reported significantly more problems with this symptom than controls. Conclusions: In comparison with non-cancer controls, disease-free CRC survivors reported overall good HRQOL but experience persistent specific detriments in HRQOL many years after diagnosis. In age stratified analyses, HRQOL deficits were noted mainly among younger CRC-LTS.
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Affiliation(s)
- Melissa S. Y. Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Ministry of Health and Consumer Protection, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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18
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Arndt V, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Doege D, Thong MSY, Brenner H. Return to work after cancer. A multi-regional population-based study from Germany. Acta Oncol 2019; 58:811-818. [PMID: 30777496 DOI: 10.1080/0284186x.2018.1557341] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: With improving prognosis, the ability to return to work after cancer has become a realistic goal but only little is known regarding details such as sustainability, financial consequences, and potential determinants of return to work in long-term survivors in Germany. Methods: We studied return to work in a population-based sample of 1558 long-term cancer survivors, diagnosed in 1994-2004 with breast, colorectal or prostate cancer before age 60 (mean 50.1). Information regarding employment status and financial difficulties was obtained via mailed questionnaires from patients who were identified by six population-based cancer registries in Germany. Cumulative incidence of return to work was determined by time-to-event analysis with consideration of competing events. Chi2 tests and multiple logistic regression modeling were employed to identify potential sociodemographic and clinical determinants of return to work. Results: Within a mean period since diagnosis of 8.3 years, 63% of all working-age cancer survivors initially returned to their old job and another 7% took up a new job. Seventeen percent were granted a disability pension, 6% were early retired (not cancer-related), 4% became unemployed, and 1% left the job market for other reasons. Resumption of work occurred within the first 2 years after diagnosis in 90% of all returnees. Cancer-related reduction of working hours was reported by 17% among all returnees and 6% quit their job due to cancer within 5 years past return to work. The probability of return to work was strongly related with age at diagnosis, tumor stage, education, and occupational class but did not differ with respect to the tumor site, gender nor marital status. Conclusions: Most long-term survivors after breast, colorectal, or prostate cancer of working-age are able to return to work. However, financial problems might arise due to a reduction in working hours. An additional provision of targeted interventions for high-risk groups should be discussed.
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Affiliation(s)
- Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Münster, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | | | | | | | - Annika Waldmann
- Ministry of Health and Consumer Protection, Hamburg Cancer Registry, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melissa S. Y. Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Doege D, Thong MSY, Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Jansen L, Brenner H, Arndt V. Health-related quality of life in long-term disease-free breast cancer survivors versus female population controls in Germany. Breast Cancer Res Treat 2019; 175:499-510. [PMID: 30826935 DOI: 10.1007/s10549-019-05188-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/25/2019] [Indexed: 01/04/2023]
Abstract
PURPOSE Little is known about breast cancer (BC) survivors' health-related quality of life (HRQoL) > 5 or even > 10 years past diagnosis. It is of interest whether, in the long run, survivors' HRQoL aligns with that of the general population. Study objectives were to (1) compare disease-free BC survivors' HRQoL to that of non-cancer controls, and (2) compare long-term survivors (LTS, 5-9 years post-diagnosis), very long-term survivors (VLTS, ≥ 10 years post-diagnosis), and controls with respect to their HRQoL. METHODS The samples of 2647 disease-free BC survivors (5-16 years post-diagnosis) and 1005 population controls were recruited in German multi-regional population-based studies. HRQoL was assessed by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Differences in HRQoL were assessed with multiple regression, controlling for age and education. RESULTS Disease-free BC survivors < 80 years (at survey) reported overall global health status/quality of life comparable to controls, but statistically significant lower physical, role, emotional, social, and cognitive functioning. They also indicated more fatigue, insomnia, dyspnoea, and financial difficulties. However, differences were only of trivial or small clinical relevance. At age 80-89, no differences between BC survivors and controls were observed. Deficits in emotional and cognitive functioning and some symptoms (e.g. insomnia and fatigue) persist, as both LTS and VLTS reported more detriments than controls. CONCLUSIONS In view of the persistent, small but significant detriments in disease-free BC survivors' cognitive and emotional functioning and higher symptom burden, possibilities to prevent detriments from becoming chronic should be explored.
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Affiliation(s)
- Daniela Doege
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- German Cancer Research Center (DKFZ), Cancer Survivorship (C071), PO Box 10 19 49, 69009, Heidelberg, Germany.
| | - Melissa Suk-Yin Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | | | - Annika Waldmann
- Hamburg Cancer Registry, Ministry of Health and Consumer Protection, Hamburg, Germany
- Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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20
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Eyl RE, Koch-Gallenkamp L, Jansen L, Walter V, Carr P, Hoffmeister M, Chang-Claude J, Brenner H, Arndt V. Potential determinants of physical inactivity among long-term colorectal cancer survivors. J Cancer Surviv 2018; 12:679-690. [PMID: 30097853 DOI: 10.1007/s11764-018-0705-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 07/18/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Since physical activity (PA) has been shown to be associated with better prognosis and quality of life (QOL) in colorectal cancer (CRC) patients, this study focuses on the barriers of PA among CRC survivors. METHODS This study is based on a population-based study from Germany of 1343 women and men, diagnosed with CRC between 2003 and 2008 and being alive five years later. Multivariable logistic regression was used to explore associations between baseline as well as five-year follow-up (5YFU) characteristics and physical inactivity (PIA) at 5YFU. Quartiles were calculated based on metabolic equivalent hours per week of PA at baseline and at 5YFU. Participants in quartile 1 were defined as physically inactive, and patients in quartile 2 to quartile 4 were defined as physically active. RESULTS Cancer-specific factors such as having a stoma (odds ratio (OR) = 1.51, 95% confidence interval (CI) = 1.12-2.04), demographic factors such as living in a small town or city (OR = 1.46, 95% CI = 1.05-2.02; OR = 1.42, 95% CI = 1.01-2.02), older age (OR = 1.44, 95% CI = 0.80-2.58), or being divorced (OR = 1.72, 95% CI = 0.96-3.07), as well as lifestyle factors such as being a current smoker (OR = 1.54, 95% CI = 1.04-2.29) or being obese (OR = 1.43, 95% CI = 0.96-2.13) were associated with PIA at 5YFU. Subgroup analyses showed that the association between body mass index and PIA was stronger in women than in men. Baseline PA was identified as a strong predictor of PIA at 5YFU. CONCLUSIONS Findings suggest that predominately patients with a stoma, patients living in a more populated area, being older, divorced, a current smoker, or obese were more likely to be physically inactive and therefore could be targeted to be more physically active. IMPLICATIONS FOR CANCER SURVIVORS Addressing barriers for PA might help to develop specific, individually tailored PA interventions to overcome PIA and improve the long-term outcome of CRC survivors.
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Affiliation(s)
- Ruth Elisa Eyl
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Medical Faculty Heidelberg, University of Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Viola Walter
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Prudence Carr
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Michael Hoffmeister
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Jenny Chang-Claude
- Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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21
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Thong MSY, Wolschon EM, Koch-Gallenkamp L, Waldmann A, Waldeyer-Sauerland M, Pritzkuleit R, Bertram H, Kajüter H, Eberle A, Holleczek B, Zeissig SR, Brenner H, Arndt V. "Still a Cancer Patient"-Associations of Cancer Identity With Patient-Reported Outcomes and Health Care Use Among Cancer Survivors. JNCI Cancer Spectr 2018; 2:pky031. [PMID: 31360857 PMCID: PMC6649846 DOI: 10.1093/jncics/pky031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/24/2018] [Accepted: 06/01/2018] [Indexed: 01/27/2023] Open
Abstract
Background The concept of cancer identity is gaining attention as more individuals are living with cancer as a chronic illness. Research is limited, and results suggest that a self-identity as “cancer patient” rather than a “cancer survivor” is associated with depression and lower health-related quality of life (HRQL). We aimed to identify factors associated with patient identity and investigate the associations between patient identity and treatment, health care use, psychosocial distress, and HRQL. Methods We used data from the population-based CAncEr Survivorship: A multi-Regional (CAESAR) study. Breast, colorectal, and prostate cancer survivors diagnosed during 1994–2004 completed a postal survey on patient identity, HRQL, psychological distress, and health care use in 2009–2011. We calculated odds ratios and the 95% confidence interval of having a patient identity. Analyses were adjusted for age, sex, education, and cancer stage, where appropriate. Results Of the 6057 respondents, colorectal cancer survivors (25%) were least likely to consider themselves patients, and prostate cancer survivors (36%) the most likely. Being male, younger age, comorbidity, higher cancer stage, and disease recurrence were associated with patient identity. Treatment was associated with patient identity, except among female colorectal cancer survivors. Having a patient identity was associated with higher health care use within the past 12 months. Survivors who still consider themselves patients were more likely to be depressed and reported significantly lower HRQL. Conclusions A significant proportion of cancer survivors still consider themselves patients five to 15 years postdiagnosis. Sensitivity to individuals’ self-identity should be considered when exploring their cancer experience.
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Affiliation(s)
- Melissa S Y Thong
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva-Maria Wolschon
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany
| | | | - Annika Waldmann
- Institute for Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.,Hamburg Cancer Registry, Ministry of Health and Consumer Protection, Hamburg, Germany
| | | | | | - Heike Bertram
- Division of Clinical Epidemiology and Aging Research, DKFZ, Heidelberg, Germany.,Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | | | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | | | - Hermann Brenner
- Division of Preventive Oncology, DKFZ and National Center for Tumor Diseases (NCT), Heidelberg, Germany.,German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
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22
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Eyl RE, Xie K, Koch-Gallenkamp L, Brenner H, Arndt V. Quality of life and physical activity in long-term (≥5 years post-diagnosis) colorectal cancer survivors - systematic review. Health Qual Life Outcomes 2018; 16:112. [PMID: 29859108 PMCID: PMC5984808 DOI: 10.1186/s12955-018-0934-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 05/15/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Due to the increasing number of long-term (≥5 years post diagnosis) colorectal cancer survivors, long-term quality of life of these patients is highly relevant. Several studies have reported a positive association between physical activity and quality of life in colorectal cancer survivors, however, so far no systematic review has been published which focuses on long-term colorectal cancer survivors. MATERIAL AND METHODS A systematic review was conducted using the databases PubMed, Web of Science, PsychINFO, and CINAHL. Studies which investigated associations between physical activity and quality of life in long-term colorectal cancer survivors were included. RESULTS AND CONCLUSION Ten articles based on seven studies were identified. Long-term colorectal cancer survivors who were physically active reported better quality of life than long-term survivors who were not physically active. Both, moderate to vigorous physical activity and lower levels like light physical activity were associated with higher quality of life. Most studies assessed the association between physical activity and quality of life cross-sectionally but one prospective study which measured physical activity and quality of life at three different points in time also found associations between physical activity and quality of life. The association between physical activity and quality of life seemed to be stronger among women than among men. The findings of this systematic review support an association between physical activity and quality of life in long-term colorectal cancer survivors. However, the evidence is limited as most studies were based on cross-sectional and observational design.
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Affiliation(s)
- Ruth Elisa Eyl
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Kun Xie
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,University of Heidelberg, Medical Faculty Heidelberg, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany
| | - Hermann Brenner
- German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Division of Preventive Oncology, Im Neuenheimer Feld 460, 69120, Heidelberg, Germany.,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- German Cancer Research Center (DKFZ), Divison of Clinical Epidemiology and Aging Research, Unit of Cancer Survivorship, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
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Thong M, Koch-Gallenkamp L, Jansen L, Brenner H, Arndt V. Do long- and very long-term colorectal cancer survivors report quality of life comparable to cancer free controls? – A population-based study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Arndt V, Koch-Gallenkamp L, Jansen L, Brenner H. Gesundheitsbezogene Lebensqualität in Ost- und West-Deutschland. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V Arndt
- Deutsches Krebsforschungszentrum, Cancer Survivorship, Heidelberg
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - L Koch-Gallenkamp
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - L Jansen
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - H Brenner
- Deutsches Krebsforschungszentrum, Klinische Epidemiologie und Alternsforschung, Heidelberg
- Deutsches Krebsforschungszentrum (DKFZ) und Nationales Centrum für Tumorerkrankungen (NCT), Präventive Onkologie, Heidelberg
- Deutsches Krebsforschungszentrum, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg
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25
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Thong M, Wolschon EM, Koch-Gallenkamp L, Waldmann A, Brenner H, Arndt V. “Still cancer patient” self-identity is associated with healthcare use among cancer survivors: a population-based study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | | | - A Waldmann
- Hamburg Cancer Registry, Hamburg
- University of Lübeck, Lübeck
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Doege D, Koch-Gallenkamp L, Waldmann A, Brenner H, Arndt V. Psychosocial resources in long-term breast, colorectal and prostate cancer survivors: Prevalence and associations with health-related quality of life. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Doege
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Epidemiologie und Alternsforschung, AG Cancer Survivorship, Heidelberg
| | - L Koch-Gallenkamp
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Epidemiologie und Alternsforschung, Heidelberg
| | - A Waldmann
- Universität zu Lübeck, Institut für Sozialmedizin und Epidemiologie, Lübeck
| | - H Brenner
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Epidemiologie und Alternsforschung, Heidelberg
- Deutsches Krebsforschungszentrum (DKFZ) und Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Abteilung Präventive Onkologie, Heidelberg
- Deutsches Krebsforschungszentrum (DKFZ), Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg
| | - V Arndt
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Epidemiologie und Alternsforschung, Heidelberg
- Deutsches Krebsforschungszentrum (DKFZ), Klinische Epidemiologie und Alternsforschung, AG Cancer Survivorship, Heidelberg
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Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H, Arndt V. Progredienzangst ≥5 Jahre nach Krebsdiagnose. Onkologe 2017. [DOI: 10.1007/s00761-017-0188-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Arndt V, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H. Quality of life in long-term and very long-term cancer survivors versus population controls in Germany. Acta Oncol 2017; 56:190-197. [PMID: 28055266 DOI: 10.1080/0284186x.2016.1266089] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND With the increasing number and diversity of cancer survivors, studies of survivors' physical, emotional, and social health are of growing importance. While there is a growing body of literature on the quality of life (QoL) of cancer patients during the early years past diagnosis, less is known regarding QoL in long-term survivors (LTS) (5 + years past diagnosis) and particularly in very long-term survivors (VLTS) (10 + years past diagnosis). The objective of our study is to: (1) compare QoL of long-term cancer survivors and population norms; and (2) assess whether any deficits in QoL of survivors observed 5-10 years past diagnosis persist beyond the 10th year past diagnosis. METHODS In total 6952 long-term cancer survivors (5-16 years past diagnosis of breast, colorectal, or prostate cancer) from Germany recruited in the context of the population-based CAESAR + study were compared with 1878 population-based controls without a history of cancer. QoL was assessed with the EORTC QLQ-C30. Differences in QoL between survivors and controls were assessed via multiple regression while controlling for age, gender, education, and case mix for survivors 5-9 years and 10 + years past diagnosis separately. RESULTS Overall QoL in long-term cancer survivors was comparable to population norms but specific deficits in social, role, emotional, cognitive, and physical functioning and symptoms such as insomnia, fatigue, dyspnea, constipation, diarrhea, and financial difficulties were more prevalent in LTSs. Detriments in QoL persisted during the observation period and affected particularly cancer survivors at younger ages (<50 years). Non-significant aggravations in QoL with longer time since diagnosis were observed in very young and very old cancer survivors. CONCLUSIONS Detriments in health-related quality of life persist over more than a decade and affect predominantly younger patients. Improvements both in early and long-term follow-up care of cancer survivors seem warranted.
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Affiliation(s)
- Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Research Center (DKFZ), Office of Cancer Survivorship Research, Heidelberg, Germany
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Münster, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | | | | | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University Lübeck, Lübeck, Germany
| | | | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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Koch-Gallenkamp L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H, Arndt V. Fear of recurrence in long-term cancer survivors-Do cancer type, sex, time since diagnosis, and social support matter? Health Psychol 2016; 35:1329-1333. [PMID: 27175578 DOI: 10.1037/hea0000374] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Fear of recurrence (FoR) is among the most important concerns for cancer survivors. Studies on potentially influencing variables, like time since diagnosis, cancer type, and sex, have yielded heterogeneous results. Also social support has rarely been examined as an influencing factor. This study aims to increase knowledge on these factors. METHOD Analyses are based on cross-sectional data of long-term survivors of breast, colorectal, and prostate cancer (5-16 years postdiagnosis), recruited by 6 German population-based cancer registries. Six thousand fifty-seven women and men were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire (FoP-Q-SF). The associations of cancer type, age, sex, time since diagnosis, and social support with moderate/high FoR were identified via multiple logistic regression analyses. RESULTS The majority of long-term cancer survivors reported experiencing FoR, mostly in low intensity. Female survivors, survivors ≤54 or 55-59 years of age, 5 to 7 years postdiagnosis, with a lower education, with recurrence/metastases, or being socially isolated were at greater risk to experience moderate/high FoR. Cancer type and stage at diagnosis did not reach statistical significance. CONCLUSION Our results indicate a potential vulnerability for women to experience FoR in moderate/high severity. Also younger and socially isolated survivors were at greater risk to suffer from moderate/high levels of FoR and should thus be monitored for high levels of FoR and be offered the support needed to manage their fears. (PsycINFO Database Record
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Affiliation(s)
| | | | - Andrea Eberle
- Bremen Cancer Registry, Leibniz-Institute for Prevention Research and Epidemiology-BIPS
| | | | | | - Annika Waldmann
- Institute of Social Medicine and Epidemiology, University of Lübeck
| | | | | | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ)
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